Washington Association of Alcoholism and Addiction Programs The Sixth Annual Providers Conference April 19-20, 2012

The Evidence for Abstinence Mick Oreskovich MD FACS UW Clinical Professor of Psychiatry and Behavioral Sciences RCKC BOD 1997-

The absence of evidence is not the evidence of absence!

Popular Perspectives on the Effectiveness of Alcoholics Anonymous 1.AA members: I know AA works and there is no need for research to prove that 2.AA critics: AA is a cult; have to believe in God; steps are a brain washing-Chris Prentiss (Passages) 3.Cochrane Review: lack of experimental evidence for effectiveness of AA and TSF 4.Send people to AA first not treatment (Moos et al, 2004)

*Abstinence Associated with Regular AA Attendance *Adapted from Kaskutas: Alcoholics Anonymous Effectiveness: Faith Meets Science. 2009; Male VA Patients >3000; Ouimette et al.,1998; Thurstin et al.,1987

*Abstinence Related to Meeting Frequency Moos et al., J Clin Psychol 2001 Male VA residential patients n = 2376 *Adapted from Kaskutas 2009

Abstinence Associated with Meeting Frequency (adapted from Kaskutas 2009) Fiorentine 1999: 250 outpatients

Abstinence Related to “Dose” of AA (adapted from Kaskutas 2009) Moos & Moos, J Clin Psychol 2006 Also see Moos & Moos, JSAT 2004 meetings 461 untreated drinkers

a Ouimette et al., J Stud Alcohol 1998 b Timko et al., J Stud Alcohol 2000 AA versus Outpatient (adapted from Kaskutas 2009) a Male VA inpatients b Previously untx prob drnkrs n = 3018n = 466

*Kaskutas 2009: Project Match: Randomize to TSF, Motivational Interview, CBT (outpatient only) PMRG, J Stud Alcohol 1997 PMRG, ACER 1998 p =.0024p <.007 Project MATCH n = 806 outpatients at yr 3

Randomize to TSF: Aftercare sample PMRG, J Stud Alcohol 1997 Project MATCH aftercare n = 714 at 1-year follow-up

Conclusions: 1.Rates of abstinence twice as high for those who attend AA 2.Higher levels of attendance relate to higher levels of abstinence 3.Prior AA attendance predictive of subsequent abstinence 4.Mechanisms of action predicted by theories of behavior change are evident at the meetings, in the 12 Steps, and in the Fellowship

Thank You! Questions?